January 2023 Newsletter

Message from the IARHC Board President

IARHC members, 

Happy New Year! We are excited for all 2023 has in store for IARHC. We know it has been a busy winter for RHCs dealing with COVID-19, flu, and RSV and we hope things are improving for your clinic.

In December, the IARHC board met for our quarterly meeting to reflect on the highlights of 2022 and what we can do to strengthen the organization in 2023. In February, the board will be gathering for a strategic planning session to outline what the next two years of IARHC will look like. This includes brainstorming priorities of the organization and what IARHC can do better to support our members. Thank you to our members who provided feedback through the IARHC Assessment sent in the weekly listserv. This information will provide insight into what IARHC members value about the organization and how we can expand our support for RHCs across the state of Iowa. The board will share key takeaways from the strategic planning session with all IARHC members in March.

It has been a busy start to the year and we can't wait share more with you soon. In the spring we will be gearing up for our annual membership drive - be sure to watch your email for more information on that and IARHC events in the coming months.

In this newsletter, you will find recent announcements from Iowa Medicaid, updates on billing and coding, policy updates in Iowa and nationally, and funding opportunities.

Best, 



Ann Wise

Board President

Clinic Director

UnityPoint Clinic Buena Vista, Sac City, and Lake View

IARHC State Capital Report

The legislative session is off to a quick start. Be on the look out for the weekly State Capitol Report from The Advocacy Cooperative. The IARHC bill tracker is the best place to find updates on where bills are in the legislative process. Bills are added daily, and bill status is in real-time, so you can always know where a bill is in the legislative process. There are already bills that:

• Designate Rural Emergency Hospitals (HF 13).
• Change the mental health professional loan repayment program.
• Create a tax on nicotine solutions used for vaping.
• Prohibit non-compete contracts with mental health professionals.
• Expand the non-compete contract ban enacted last year.
• Eliminate the certificate of need process.
• Create a team of legal experts to allow CBD use in nursing homes and schools.
• Establish a professional counselor license compact.
• Eliminate barriers to prescribing psychologists.
• Add more eligibility screenings for public assistance programs, including requiring recipients to verify their identity online (similar to what people do for bank access).
• Update child car seat laws to align with new recommendations.
• Prohibit schools from discussing gender identity and sexual orientation in grades K-3.
• Prohibit schools from accommodating gender non-conforming students unless parents approve (and requiring teachers to "out" kids if asked by parents).

View the State Capitol Report from this week here.

Iowa HHS Launches New Website

On Thursday, January 12, 2023, HHS launched a new website at https://hhs.iowa.gov. The Iowa Medicaid portion of the new website mirrors the structure and content of the previous website. HHS will temporarily maintain a redirect service for the legacy site at https://dhs.iowa.gov. At this time, there are no changes to sites that do not have a DHS domain, such as the Iowa Medicaid Preferred Drug List and the Iowa Medicaid Portal Access (IMPA).

Providers should update any bookmarks or links they have for the previous website. Any link or bookmark pointing to dhs.iowa.gov (and its subsequent pages) will need to be changed to hhs.iowa.gov. For example, a bookmark pointing to the Provider Services page dhs.iowa.gov/ime/providers will need to be changed to hhs.iowa.gov/ime/providers.

HHS is currently processing changes to website links contained within forms and documents. Providers should check the HHS website regularly as these updated forms and documents become available in the coming weeks.

Webinar with Iowa Medicaid: Continuous Coverage Requirement Ends on April 1

Iowa's continuous coverage requirement for Medicaid members will end on April 1, 2023. At this webinar, Medicaid team members will share details about the state's plan and what members can expect in the coming weeks and months. Medicaid stakeholders, providers and other partners are encouraged to attend. The meeting will take place on January 25, 3 p.m. - 4 p.m. Sign up for the webinar here. If you are a part of UnityPoint, please email [email protected] to RSVP. Learn more about the Continuous Coverage Unwind Plan and sign up for notifications here.

For more information, read the full CMCS Informational Bulletin here.

Governor Reynolds expands registered apprenticeship grants to grow health careers

DES MOINES, IOWA – Yesterday, Governor Kim Reynolds announced during her Condition of the State address a new $15 million round of funding targeted at growing Registered Apprenticeship (RA) programs across high-demand fields in health care. The expanded Health Careers Registered Apprenticeship Program will support more programs that help Iowa meet the demand of its health care workforce. 

First introduced last year, Iowa’s Health Careers pilot supported RA programs that help students pursue nursing pathways. This year’s program greatly expands opportunities for health care apprenticeships to include EMTs, RN’s, Direct Support Professionals, Behavioral Health & Substance Abuse Specialists, and other critical areas. To receive funding, the RA programs must provide an industry-recognized credential that can also be stackable and used to advance a career in health care. Funding priority and preference will be given to partnerships that involve private or public accredited Iowa high schools.       

“This new grant opportunity builds on the success we initiated last year and expands the number of available pathways Iowans can take to gain critical experience in one of the most important sectors of our economy,” said Governor Reynolds. “Apprenticeships are working in Iowa and opening important doors. We want to do everything we can to get Iowans engaged in the workforce and set up for meaningful careers.”   

Applications for this year’s Health Careers Registered Apprenticeship Grant Program will be accepted on IowaGrants.gov beginning today, January 11. The deadline for applications will be March 9, 2023 at noon. 

• A total of $15 million is being made available for this funding opportunity. Visit this link for grant documents and information on how to apply. 
• A grants webinar will also take place on January 27 at 11:00 AM to highlight the application process and answer questions. Interested participants are encouraged to join. (RSVP Link) 

“Iowa is always looking to open more doorways to new careers, and registered apprenticeships are proving that this is possible even in the highest-demand fields,” said Beth Townsend, Director of Iowa Workforce Development. “Research shows that most apprentices will pursue careers in the same fields as their apprenticeships, so we welcome any applicants who are ready to help us expand the number of health care career options in Iowa.”

The health care and social assistance industry continues to have the highest number of job openings on IowaWorks.gov (approx. 12,000) and had four out of the top ten job postings in Iowa as of January 11, 2023. The grant program is designed to support the development or expansion of health care RA programs that are sponsored by Iowa-based Nursing Facilities, Residential Care Facilities, Assisted Living Facilities, Hospitals, Home Health Agencies, and Public/Private accredited Iowa High Schools, Community Colleges, and Universities.

Visit this link for grant documents and information on how to apply.

Maintaining Compliance in Your RHC

You may have gained your RHC certification 15 years ago or just last week, but now what? Certification is only the beginning. A clinic is a participant in the RHC program and must maintain 100% compliance at all times. Join NARHC for an upcoming webinar on Thursday, January 26th, 2023 at 2 PM CT where Tressa Sacrey, valued RHC consultant with Health Services Associates, Inc. will review a helpful toolkit to help you stay in compliance and avoid pitfalls in preparing for your next survey!

You must register in advance for the Free Webinar! RHCs can submit questions during registration or ask them live during the webinar. Register for the webinar here.

Date: Thursday, January 26th, 2023, at 2 PM CT

Title: Maintaining Compliance in Your RHC

Speaker: Tressa Sacrey, Compliance Analyst, Health Services Associates, Inc.

Moderator: Sarah Hohman, NARHC Director of Government Affairs

Rural Health Clinic All-Inclusive Rate: CY 2023 Update

Learn about updates to the rate effective January 1, 2023, and make sure your billing staff knows about the updates including:

• Payment limit per visit
• Payment limits for specified (grandfathered) provider-based rural health clinics
• Cost report data requirements

COVID-19: Updated Vaccines for Children Ages 6 Months - 5 Years and CPT Codes

On December 8, 2022, the FDA amended the emergency use authorizations of the updated (bivalent) Pfizer-BioNTech and Moderna COVID-19 vaccines to include use in children down to 6 months old. Your patients may know these as “updated COVID-19 vaccines”:

• Pfizer-BioNTech: all patients 6 months – 4 years old. Get important prescribing information.
• Moderna: all patients 6 months – 5 years old. Get important prescribing information.

Use 4 new CPT codes effective December 8, 2022:

Code 91316 for Moderna COVID-19 Vaccine, Bivalent Product:

• Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, for intramuscular use
• Short descriptor: SARSCOV2 VAC BVL 10MCG/0.2ML

Code 91317 for Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product:

• Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
• Short descriptor: SARSCOV2 VAC BVL 3MCG/0.2ML

Code 0164A for Moderna COVID-19 Vaccine, Bivalent - Administration – Booster Dose:

• Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, booster dose
• Short descriptor: ADM SRSCV2 BVL 10MCG/0.2ML B

Code 0173A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent - Administration – Third Dose:

• Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, third dose
• Short descriptor: ADM SARSCV2 BVL 3MCG/0.2ML 3

Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. 

Certificates of Medical Necessity and DME Information Forms Discontinued January 1

You don’t need to submit certificates of medical necessity (CMNs) and durable medical equipment (DME) information forms (DIFs) for claims with dates of service on or after January 1, 2023. If CMS gets a claim with a CMN or DIF, we’ll reject the claim and return it to you.

For services before January 1, 2023, continue to submit CMN and DIF forms if required.

See MLN Matters Article SE22002 for more information.

Clarification of Iowa Medicaid Breast Pump Coverage

Iowa Medicaid released an informational letter providing clarification of coverage for electric and manual breast pumps. Information includes coverage, criteria, limitations, and billing. Read the full informational letter here.

Medicaid and CHIP Continuous Enrollment Unwinding: A Communications Toolkit

In March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily waived certain eligibility requirements for Medicaid and the Children’s Health Insurance Program (CHIP) to help people keep their health coverage during the pandemic. Last year, CMS announced states would have to return to normal eligibility and enrollment operations once the official Public Health Emergency (PHE) had ended – a process referred to as “unwinding.” Last week, it was announced that the PHE would be extended by another 90 days to mid-April. However, new legislation calls for eligibility waivers and other pandemic-related flexibilities to end on March 31, 2023.  

This toolkit, provided by CMS, has important information to help inform people with Medicaid or CHIP about steps they need to take to renew their coverage. View the toolkit here and see how your clinic can utilize this resource.

CMS Delays Enforcement on Phase II of Good Faith Estimate Policy

In early December, CMS released guidance stating that the Good Faith Estimate (GFE) requirement to include cost estimates for co-providers/co-facilities set to go into effect January 1, 2023 has been delayed. While we acknowledge that the GFE requirements in place since January 1, 2022, continue to present an administrative burden to many RHCs, we are pleased that CMS has not added further complexity to the process at this point. Read more information provided by NARHC here.

Preparing for Medicaid and CHIP Unwinding Webinar

In March 2020, the Centers for Medicare & Medicaid Services temporarily waived certain eligibility requirements for Medicaid and the Children’s Health Insurance Program (CHIP) to help people keep their health coverage during the pandemic. When the public health emergency ends, states will be required to restart eligibility reviews. This session is part of a monthly learning series to help states prepare for the change.

Join this CMS webinar, Medicaid and CHIP Continuous Enrollment Unwinding: What to Know and How to Prepare, A Partner Education Monthly Series on Wednesday, January 25th at 11:00 AM CT. Register here.

2020 Census Changes Leave Rural Health Clinics in Legal Grey Area

Since the inception of the RHC program in 1977, the Rural Health Clinic program has used the Census Bureau’s definition of “urbanized area” to determine if a site met the rurality requirements to establish an RHC. Specifically, the RHC statute says:

For the purposes of this title, such term includes only a facility which (i) is located in an area that is not an urbanized area (as defined by the Bureau of the Census)...Read more information provided by NARHC here.

NARHC Policy Updates

2023 Regulatory Updates for RHCs

In November 2022, the Centers for Medicare and Medicaid Services (CMS) issued the CY 2023 Medicare Physician Fee Schedule (MPFS) Final Rule. This year’s rule finalizes several Rural Health Clinic (RHC) policies originally proposed in July 2022, which NARHC summarized. Read more here.

Congress Passes FY2023 Omnibus

The Consolidated Appropriations Act of 2023, also known as the yearly “Omnibus” package which will fund the federal government for the remainder of Fiscal Year 2023 passed in late December, narrowly avoiding a government shutdown. Several provisions impacting Rural Health Clinics appeared in the final legislative text. Read more here.

Grant and Funding Opportunities

Forthcoming Grant Opportunities for Rural Health Clinics | An Update from NARHC

See a recent update, provided by NARHC, on new funding opportunities made available to RHCs.

The Consolidated Appropriations Act of 2023, which was recently signed into law to fund the government for the duration of Fiscal Year 2023, contains two grant opportunities where rural health clinics are explicitly listed as eligible applicants. While more details will assuredly accompany the notice of funding opportunity on grants.gov, the legislative text gives us a good idea of the key components of each grant.

Integrated Care Services

The first grant opportunity, designed to “improve uptake and patient access to integrated care services” would provide up to $2 million per grantee to promote the integration of physical and behavioral health care, a concept that the legislative text defines as “bidirectional integrated care.” Specifically, the funding is designed to help practices set up the psychiatric collaborative care model which many RHCs will recognize as the G0512 special payment code. For folks who may have been hesitant to try this particular care management code in the past, this grant may provide the impetus you need to begin offering this service.

Grantees would be able to use the money to hire staff and/or contract with health care providers or other entities offering care management and behavioral health consultation. The legislation also mentions that funding can be used to purchase or upgrade software needed to provide behavioral health integration.

As most of you are aware, there is an extra wrinkle to consider for RHCs when integrating behavioral health care with physical health care. Specifically, RHCs are currently statutorily prohibited from being primarily engaged in “the treatment of mental disease.” Furthermore, CMS has not provided clear ways to measure physical care relative to behavioral health care and some RHCs have run into issues on their survey because they were providing too much behavioral health care.

Considering the clear policy intent of Congress to integrate behavioral health with primary and specialty physical care, and the blurring of lines between behavioral health care and physical health care, NARHC is working to change this law. The “RHC Burden Reduction Act” which we hope to have introduced in the next few months, would amend the statute to allow an RHC to provide a majority of behavioral health care if the RHC is located in a mental health-HPSA. Getting this language passed should make it much easier for RHCs to provide “bidirectional integrated care” without fear of jeopardizing their RHC status. This opportunity was funded at $60 million for the next five years.

Continuing Education Support

The second grant opportunity expands eligibility of an older grant program to pay for the continuing medical education of health care providers that work at RHCs. The legislation does not specify a maximum amount per grantee, but it does appropriate $5 million over three years to fund this opportunity.

Grantees should be able to use this funding to pay for “distance learning, continuing educational activities, collaborative conferences, and telelearning activities.” The text makes it clear that this funding can be used to pay for “educational activities that include a clinical training component, including in-person patient care.”

HRSA Payment Program for RHC Buprenorphine-Trained Providers

Update: Clinicians no longer need DATA 2000 Waiver training to prescribe buprenorphine; however, the payment program to defray earlier training costs is still active. Launched in June 2021, the initiative pays for providers who previously received a waiver to prescribe buprenorphine, a medication used to treat opioid use disorder. Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who previously trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019. Approximately $900,000 in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted. Send questions to [email protected].

Application Assistance for HRSA Nurse Corps Loan Repayment Program

The first of two informational webinars for the federal program that pays up to 85 percent of unpaid nursing education debt in exchange for work in an underserved area or nursing school. Join the webinar on Thursday, January 26th at 1:00 PM CT. Register and find more information about the program here.  

NOSORH Rural Health Grant Writing Institute

From February 27 to May 8, 2023, the National Organization of State Offices of Rural Health (NOSORH) offers a series of nine online learning sessions that cover grant writing with a unique rural health focus. There is a $750 registration fee with a discount for five students registered together. For more information visit the NOSORH website here.

NARHC Spring Conference Registration Open | March 20-22, 2023

The NARHC 2023 Spring Institute will be held in San Antonio, Texas March 20-22, 2023. NARHC Institutes are put on by the only national association dedicated strictly to Rural Health Clinics (RHCs). A wide range of rural health professionals will be in attendance including CEOs, CFOs, Physicians, PAs, NPs, Clinic Managers, Billers & Coders. Visit the NARHC website for more information about registering, agenda, and travel accommodations.

IARHC Staff Members

Hannah Toresdahl

[email protected]

515.237.0328

Iowa Association of Rural Health Clinics | www.iarhc.org | [email protected]